Study promotes early treatment of prostates -Elderly men have been advised to forgo surgery and therapies.

December 13, 2006|ROB STEIN The Washington Post

WASHINGTON -- A large new study is challenging the common practice of recommending that elderly men forgo treatment for early prostate cancer and instead wait to see whether the malignancy progresses. The study of more than 44,000 American men ages 65 to 80 found that those who chose to aggressively treat their prostate cancer with surgery or radiation were about 30 percent less likely to die than those who waited, indicating that treatment offered a clear advantage. The research, published in today's Journal of the American Medical Association, is the first to directly examine what has been become conventional wisdom: that many elderly men need not treat early prostate cancer because it tends to grow so slowly that they will probably die of something else first. "For many years the thinking has been that observation or 'watchful waiting' was the safest option for elderly patients with early prostate cancer," said Yu-Ning Wong of the Fox Chase Cancer Center in Philadelphia, who led the study. "This suggests there may be a benefit of treatment, even in this age group." The findings prompted debate among specialists, who said the results could have potentially far-reaching implications because they address one of the central quandaries about prostate cancer and because the disease is so common. It strikes 235,000 U.S. men each year and kills more than 27,000, making it the most common cancer and second leading cancer killer, after lung cancer, among men. Most cases are diagnosed after age 65. Some experts said they hoped the findings would encourage more doctors to consider treating elderly men. "This debunks the idea that older men do not benefit from treatment," said Christopher Amling of the University of Alabama in Birmingham. "This gives support to the idea that active treatment can be beneficial." Others experts, however, expressed skepticism, saying the study's design may have missed another explanation for the lower death rate among men who were treated: They were probably healthier in ways that doctors can only tell from examining them in their office, not from looking at their medical records, which is what the study's authors did. "There was probably something about these guys that made them more likely to get treated that also made them more likely to survive," said Mark S. Litwin of the David Geffen School of Medicine at UCLA, who co-authored an editorial accompanying the paper. Wong acknowledged that the study's design had limitations, making it important that the findings be confirmed by additional research.